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Forum Name: Rheumatology Topics

Question: Plasma VMA elevated


 sylviab - Wed Sep 10, 2008 6:49 pm

Aside from elevated urine VMA and plasma VMA I am experiencing chronic arm and hand throbbing along with weakness. I have unexplained weight loss. At 66inches, I weigh 109lbs. I was diagnosed with Fibromyalgia in 1994 but my symptoms are worsening with regard to aches/pains and chronic fatigue. My vision is blurring, especially with respect to left eye. Many of my headachaes are left occipital area. Migraines are more frequent and severe in the last 9months. My BP is dropping, generally now 96/54. I experience episodes of feeling faint, even when sitting or standing still. I am 5yrs post menopause.
Thank you for your reply(ies)~S
 Tom Plamondon PA-C - Mon Dec 22, 2008 1:10 pm

User avatar Thanks for your patience.
First, for chronic migraine headaces. It is important to assess medications that may cause rebound (e.g Fioricet or triptans). Then look at triggers especially food and medication (eg caffeine, chocolate, MSG, nitrates/nitrites in food). Then consider prophylactic medications.
Unexpected weight loss is a concern. Have your family physician do a complete history and physical. A CT of head may be warranted.
Throbbing arm and hand pain could stem from Raynauds. Use caution with some medicine for Raynaud like topical nitro cream as these can trigger migraine. Is this the same arm as the rotator cuff repair?
The VMA in urine is checking for pheochromocytoma which is caused by a tumor on the adrenal gland. Classic findings include headache, high blood pressure or fluctuating BP, excessive sweating, heart palpitions, hyperglycemia, and hypermetabolism (which would include weight loss). Other testing includes 24 hour urine and/or plasma metanephrines; CT or MRI of the abdomen...adrenal glands which are found on top of kidneys.
Again follow up with family physician is important to sift through these signs and symptoms.
Let us know how things go.

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